Individual
SUSAN P HERTWECK
Active
Individual
SUSAN P HERTWECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
25239
KY
2080A0000X
Pediatric Adolescent Medicine Physician
25239
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045416
ANTHEM - PSC
KY
01
—
000000047600
ANTHEM - FOUNDATION
KY
05
—
100332440
—
IN
01
—
1049241
PASSPORT PCP# - FOUNDATION
KY
01
—
1049243
PASSPORT SPECIALITY - FOUNDATION
KY
01
—
1049273
PASSPORT SPECIALITY - PSC
KY
01
—
50034184
PASSPORT & PASSPORT ADVTG
KY
05
—
64252398
—
KY
01
—
K027510
MEDICARE PTAN
KY
Enumeration date
07/17/2006
Last updated
05/26/2020
Update your record
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